TIMELY DELIVERY OF BIOLOGICAL THERAPY AFTER CYTOREDUCTIVE NEPHRECTOMYIN CAREFULLY SELECTED PATIENTS WITH METASTATIC RENAL-CELL CARCINOMA

Purpose: We determine whether cytoreductive surgery delays or preclude s the administration of systemic biological therapy in patients with p reviously untreated metastatic renal cell carcinoma. Materials and Met hods: We evaluated 79 patients 22 to 73 years old with untreated renal cell carcinoma for possible cytoreductive surgery before the administ ration of systemic biological therapy. Based on performance status, ov erall disease burden and subjective clinical assessment 13 patients we re referred for initial systemic biological therapy and 66 underwent c ytoreductive surgery as initial treatment. We evaluated patient abilit y to receive postoperative biological therapy, time to therapy, surgic al complications and mortality. Results: Cytoreductive surgery had a m inimal impact on the administration of timely systemic biological ther apy in these carefully selected patients. Of the 66 patients 54 (82%) received postoperative systemic biological therapy beginning a median of 40 days after nephrectomy. Two patients (3%) died postoperatively ( within 30 days) and in 1 (1.5%) postoperative deterioration in perform ance status precluded the administration of systemic therapy. The othe r 9 patients did not have measurable residual disease postoperatively, did not need or refused systemic therapy, or were followed elsewhere. Conclusions: Systemic biological therapy can be administered in a tim ely manner (median 40 days) to the majority of patients (82% treated) after cytoreductive surgery. Surgery alone does not preclude the admin istration of systemic biological therapy in carefully selected patient s.